A 21-year-old G3P2, was referred at 8 months gestation for ultrasound evaluation of the limbs, suspected to be short. That was the first child of the couple, but both partners had healthy children in previous marriages. Her past and prenatal histories were unremarkable except for smoking one pack of cigarettes per day.

The examination revealed a single live gestation at 35 weeks, with multiple anomalies. All limbs below the 5th percentile

The arm:

Humerus

Femur

One hand

The other:

Other view of that same hand

One kidney

The other

The atrium

The head with measurements of the biparietal diameter and occipitofrontal diameter

The mouth

Two views at the level of the 4-chamber of the heart.

A commonly performed diagnostic procedure was then performed. The result of that procedure was normal.

By the way, for all of you who might think that I find all these diagnoses: I do not ! I completely missed this one and I fully expect to be mortified by all the good answers that this group typically suggest.

When you have tried to solve the case on your own (no team work here please !) you can find the Answer here.